Not Just Words

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Friends, it’s been another week of observing, processing, learning, and integrating.  Holy cow, I really need this vacation.  I need nature, time with family away from work, away from the news.  I need to take a breath.

Things feel different this time.  I think this cautiously; I allow it—hope.  Change will be incremental and slow, but I feel a real acceleration today.  Equality is an infinite game, and we who play to advance it find ourselves in a moment of palpable solidarity and purpose.  But what comes next?  What will the field look and feel like at the end of the summer?  In a year?  In ten years?  When my kids are my age? What progress will we look back and see, initiated in this movement of 2020?  How can we make this a turning point?

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Stories

First, we must seek to understand the scope and nature of the challenge.  For many of us this means listening.  “Facts don’t change our minds.  Friendship does,” James Clear writes.  We humans are not rational, logical beings at our core.  We change our minds when we can relate to someone else’s experience, and the best way to do that is to listen to their stories.

Here are some stories that moved me this week:

Reflections of a Token Black Friend by Ramesh A. Nagarajah:  I think back to when my friends never understood why I wasn’t allowed to play with water guns — or any toy guns, for that matter — when I was a boy. I’d be so excited to visit a friend’s house and use their airsoft gun in the backyard. I used to get so frustrated when my mom told us it was “too dangerous” for black boys to do that and that someone would mistake it for a real gun. When I was 16, 12-year-old Tamir Rice was shot and killed while playing with a replica toy airsoft gun. I realized my mom was right.  …I think of the way the black girls were treated as second rate in high school. Guys rarely tried to talk to them romantically, and if they did, others discussed it with an undertone of comedy. I never felt this way, personally, but didn’t realize until college that my silence was compliance. I was participating in denying dignity to the black women around me.

A passionate and powerful video by Kimberly Jones, author of I’m Not Dying With You Tonight, which is now in my queue.  Listen and watch to the end.  Embrace the discomfort.  Whatever you experience in these few minutes is nothing compared to what Black people have suffered for generations.  Then mull over her last sentence.

A heartfelt and important essay by Dr. Marie Ramas, on her role as a Black woman primary care physician during a pandemic:  Once again, as a healer working in a system seemingly based more on economics than wellness, I felt forced to make an impossible ethical decision. Then, I realized that the underlying question for me to answer was not whether I would treat individuals at the risk of my own self. Rather, I needed to pan out my scope of view and ask, “How can I help rebalance the scales of justice to reflect the inherent worth of the black and brown lives that I both serve and represent?”

Sensational six FB Humans of St Louis 1 of 7 June 2020

The Sensational Six:  Six Black women graduated from the pediatrics residency at Washington University St. Louis this month.   Follow the link to read the 7 consecutive posts about these remarkable women, and look for their mark on our future.  Their names are

Fehintola Olaiya, MD
Stephanie Diggs, MD
Frances Annan-Fohtung, MD
Mia Henderson, MD/PhD
Olivia Beaubrun, MD
Tobi Olayiwola, MD

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Connection, Action, Accountability, and Togetherness

The goal of all this seeking and listening, of course, is Connection.  The only way to get to shared humanity—true connection—is stories.  And the only way to stay in the infinite game fighting against structural racism is to play together, team members rotating on and off the field.  The metaphor of a choir holding the prolonged single note, strong and clear, by staggering each person’s breaths, applies here.

The team is huge—every one of us has a role to play and a contribution to make.  What Actions can we each take?  Here is a list of 75 to choose from.  Start now.  No action is too small.  Do it sincerely, consistently, and with integrity.

How will we hold each other Accountable?  Company after company declares their opposition and intolerance to racism.  “It’s all words,” as one Black woman told me bluntly.  We need metrics, goals, and transparency.  Medical schools must recruit more students of color.  Companies must promote more people of color to designated leadership roles.  Citizens must demand of our legislators to address systemic and institutionalized discrimination, to give it tangible consequences that motivate change.

Most importantly, we must do the deep work of ferreting out where bias hides in our institutions, understanding clearly how it impacts our practices for the worse, and then reworking our systems to eliminate, or at least moderate, those negative consequences.  The legend of the Boston Symphony Orchestra’s blind auditions can instruct us here.  We can claim success when we see people of color represented proportionally in leadership, policymaking, and all of the most influential and impactful aspects of our culture.

We have so very far to go.  But at least it feels, for the time being, that more of us have opened our eyes to the path ahead.  And rather than turning (running) away, we turn toward—Together.  We find each other’s hands and grab on, holding tight.  We take one tentative step, then another, and another.

If we keep walking, together, we will make progress.

The Power and Potential of Blind Spots

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Whoa Nellie, what a week.  How are you?  What’s vexing you most right now?  What’s holding you up?

A 651 KB PDF sits portentously in my work inbox.

It’s the report of the 14 people who completed surveys for my 360 leadership evaluation.  What a fantastic learning opportunity (assuming the feedback is concrete and actionable)!  I had planned to do it last winter, and then I procrastinated.  And then the pandemic hit.  At home and not seeing patients, I debated whether to bother people with such a frivolous ask.  I decided to proceed because as a leader, what better chance and reason to get real time feedback than during a crisis?  And will there be a better time in the coming months?  I am grateful to/for the 14 respondents.

My biggest fear is that I will be blindsided, and then frozen, by unexpected and severely negative feedback.  I’d say I have a moderate case of imposter syndrome.  So this report carries, in my lizard brain, a high risk of confirming every insecurity I harbor about my leadership, personality, and value to my (any!) organization.  *deep breath*

Johari Window

https://www.communicationtheory.org/the-johari-window-model/

 

Thankfully I am more than my threat-vigilant self; I can receive feedback calmly and rationally.  And, I have support.  One of my LOH classmates introduced me to the Johari Window model the other day.  How have I not come across (remembered) this model before now?  Into the first of the four panes, my ‘Arena’, I put aspects of my leadership style that are known to both myself and others—strengths and weaknesses.  A second pane, my ‘Façade,’ comprises things known to me but that I conceal from others.  These can include deep seated fears, insecurities, traumas, and other emotional baggage.  I bet many of us underestimate the influence and consequences of façade traits on our leadership style and results.  My 360 will show what lives in the upper right pane, my ‘Blind Spot(s)’—what is known to others and not known to me—hence the risk for being ‘blindsided.’  Finally, the parts of my leadership that are as yet unknown to both myself and to others are simply labelled ‘Unknown.’  I have renamed this quadrant ‘Potential for Supported Learning and Growth.’

The best possible result from this 360 exercise is a new, clear, and useful awareness of my leadership Blind Spots.  In her book Insight, Tasha Eurich asserts that true, effective self-awareness embraces and processes both the self-known and other-known domains, and their intersection.  I plan to map out my Johari Window for both strengths and weaknesses before opening my report.  Then I can organize them into broad categories as a framework for approaching the results, and see how well they reconcile (or not).

But beyond professional leadership in my little clinical practice, how else can I apply this self-awareness framework?  How can this exercise inform larger, more global  relationships and culture?

Racism

In July, 2016, I wrote this post about racism and listening for peace.  I’m glad to have documented my thoughts and experiences over the years.  Rereading it now, I can see how I have both sustained and evolved my attitudes on addressing racism.  I still respect all points of view, at least partially.  But I am now more willing to take risks and engage in the hard conversations, to show that I have the capacity to address complexity, to hold tension between divergent and opposing perspectives.  I used to fear being misconstrued as a member of an antagonist monolith.  I am less afraid today to confront such assumptions that others may make of me (and I of them), to invite dialog, to withstand the discomfort of digging in and exchanging in earnest.  This includes with those whose ideology I oppose, as well as those with whom I align.

A principal value of inviting divergent dialog, like the 360 evaluation, is to reveal my Blind Spots.  For instance, even as I think of myself as ‘not racist,’ what behaviors have I that actually are racist, or at least ignorant and complicit?  How can I be more anti-racist?  What can the mirror show me that I can act on and improve, to make a positive difference?

For more on the vital importance and dire need for more of this kind of engagement and self-reflection, read David French’s piece from this morning, “American Racism: We’ve Got So Very Far to Go.”

For an excellent example of how Blind Spots manifest publicly, and how this can instruct us, read John Pavlovitz’s excellent essay on how Drew Brees slammed straight into the mirror as blind as any of us.

We can all map out Johari Window panes for our racism and anti-racism, just like leadership strengths and weaknesses.  Then we can shut up and listen to our Black friends and colleagues, learn in earnest about how racism really is built into and manifests in every aspect of our national heritage and culture.  We can speak up and act when we witness racist thought, attitude, behavior, words, decisions, and policies.  Each of us, in small and still significant ways, can lighten the burden our Black peers carry—we can and should share the work of dismantling our oppressive and marginalizing, racist systems.

It all starts with awareness—the closer to 360 the better.

Trust and Safety in an Uncertain World

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Suddenly I felt my heart pounding.  My palms got sweaty.  My jaw felt tense.  I’m anxious, I realized.  It felt like sometimes when I speak up in big meetings.  Wow, I don’t even have to be in front of people for this to happen, how fascinating.

It was the second or third comment I had written on another Facebook page, belonging to a high school classmate.  I think we became ‘friends’ through his wife, a friendly acquaintance of mine in high school, with whom I’ve been connected on Facebook for several years.  I don’t really know her husband at all, and yet here I was, writing long replies on his page about universal masking, why recommendations changed between March and now, and why I trust Dr. Fauci despite his apparent flip-flop on this issue.

I had entered someone else’s house, offering my unsolicited opinions.  Though we have a handful of mutual friends, I had no idea who else would attend this party, and whether I would be welcome.  I wasn’t sure it was safe.

And yet I felt compelled to enter, why?  Perhaps I felt defensive of my professional standard bearer, Dr. Fauci, the father of modern infectious disease and icon of science, medicine, and public health.  He has basically led the research to define and defeat HIV/AIDS since the 1980s.  Through six administrations, he has directed the National Institute of Allergy and Infectious Diseases (NIAID) to successfully manage H1N1, Ebola, and Zika, at home and abroad.  He is one of my heroes.  Likely, I also wanted to absolve myself a little, as I had also recommended against masking in public early on.  I wanted to help some strangers see us, the ‘experts’, as human and fallible, and also earnest and caring, worthy of heeding.

So I obsessed over my comments.  I read and reread before posting.  I edited after posting.  I included the links embedded above, inviting anyone on the thread to hear Dr. Fauci in his own words, in full.  I offered my own mea culpa twice, explaining how academics sometimes fall victim to ivory tower thinking, as we did in this case.  Perhaps this was my attempt at earning back whatever trust people may have lost because we experts contradicted ourselves in such an important and pivotal moment.  I regret this, and I wanted people to know, and then maybe not hold it against me (us).  Would I be crucified?  Or would I crack a door open to hearing what I had to say?  I feel anxious now, just thinking about it again.

My own friends discussed this on my page a few weeks ago, after my post on antibody testing (our recommendations have not changed yet).  Paul, MD PhD and rheumatologist, pointed out, “US experts really blew it initially when it came to masks… All they had to do was consider the possibility that Asian countries might be right and then consider that the risk associated with (masking) was virtually zero.  The first thing experts need to do, when confronted with circumstances that are truly new to them, is admit uncertainty and base recommendations accordingly.”  I’m so lucky to have such honest and direct friends.  I replied that I felt badly for following the ‘expert’ advice like a sheep (which is exactly how others on my acquaintance’s page described followers of universal masking, yikes).  “Lesson learned,” I wrote—but have I really learned it?  David, Paul’s and my classmate who now leads quality and hospitalist programs at his institution, replied, “It’s weird to be here with you (two) bashing experts, since the three of us are by any definition, experts.  But the value of experts is not that they’re always right, but that they have a) a better track record and b) the ability to self-correct.”  Yes, humility is key.

It all makes me wonder, how do we trust someone?  I have conversations every day with patients and non-medical friends and family, educating and advising, and they are appreciative; they trust me.  But we have already established mutually respectful, personal relationships.  What made me think I could go on this unfamiliar man’s social media page, interact with perfect strangers, and have them trust or accept anything I said, when they had already expressed reservations about, if not hostility toward, my ‘tribe’?  Was it my place?

The original post commented on universal masking and referenced Dr. Fauci not in a snarky, pejorative, or aggressive way.  If it had I would have scrolled right by.  Because it was a neutral presentation, I felt it could be safe to enter this house and offer my perspective.  Out of respect for the page owner and his friends, I did my best to present both humbly and objectively, to be informative but not condescending.  I really wanted to put my best online foot forward, to represent my tribe and my profession as well and as trustworthily (it’s a word!), as possible—to connect.  So far I have not been attacked, and a few readers have liked my comments.

In the end, as I have written before, I think it’s about how we show up to one another.  I wrote recently about tribal culture, and how through this crisis, individuals can help our own tribes thrive by modeling a more collaborative rather than competitive mindset, by amplifying our togetherness.  “Who do we want to be on the other side of this crisis?” I asked.  David Logan and colleagues go on in their work to discuss how tribes can effectively interact with other tribes, forming alliances and advancing even greater good together.  They posit that tribes draw closer when their respective members, especially designated leaders (representatives), connect.

We find ourselves now in an existential battle for our lives, literally.  Now is exactly the time to find common ground, step onto it, set up camp, and make decisions from there—to merge tribes.  A friend asked me today, “Who do you want to be now?”

I want to be a connector, I answered.  I will do my best not to contribute to division, polarization, alienation, disconnection, and suffering, through my words or actions.  I will not be perfect.  I will make mistakes.  I will continue to learn and apply.  I will strive to earn and maintain people’s trust.  And I will help make it safe for people to question and challenge, discuss and explore any point of view.  In the face of uncertainty, this is what I can offer.